Harvard Heart Letter

COURAGE to make choices

When it comes to treating angina or a narrowed coronary artery, angioplasty is no better than medical therapy for preventing heart attacks or premature death.

What's the best way to "fix" a narrowed coronary artery? That question was the crux of a multimillion-dollar trial dubbed COURAGE, short for Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation. Its results, presented in the spring of 2007, stunned some doctors and seemed to shock the media, but we hope they won't come as a surprise to readers: For people with stable coronary artery disease (clogged arteries nourishing the heart), artery-opening angioplasty was no better than medications and lifestyle changes at preventing future heart attacks or strokes, nor did it extend life.

The media tended to play up the COURAGE results, which were presented at the American College of Cardiology's annual meeting in March, as a David slays Goliath story. But it wasn't that at all.

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